| NPI | 1609515469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WY 4394) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WY N4704) |
| 183500000X Pharmacist (Licence: NE 17547) | |
| Enumeration Date | 2022-05-31 |
| Last Update Date | 2022-07-14 |